Jan 29, 2015The Missing Joint
By Jeremy Lawson
These days, it’s not difficult for a strength and conditioning coach to educate him or herself about joint mobility and stability. A lot of this comes from using Functional Movement Screens, the Joint By Joint Approach, or gathering data from studies pertaining to symmetries and asymmetries.
But recently, as I was seeking information about the relationship between mobility and stability, I also learned valuable lessons from a National Upper Cervical Chiropractic Association (NUCCA) spine doctor.
To my fascination, I found that the people who developed the Functional Movement Screen and the Joint By Joint Approach say a lot of the same things this NUCCA doctor has said regarding asymmetries, mobility and stability. The only difference is the NUCCA doctor has explained that optimal symmetry, mobility and stability begins at the atlas bone, the closest bone to the brain stem.
I have never heard a strength coach, athletic trainer, or physical therapist talk about the atlas bone, therefore I am calling it the missing joint. I think learning about the atlas bone can help the athletic performance world understand why so many athletes have asymmetries.
In May 2008, I met my NUCCA spinal care doctor and then began to learn and personally experience the atlas bone’s contribution to human strength and function. I have had some success with chiropractors, but we all know that the treatment consists of forceful manipulation of the spine in hopes of gaining proper alignment, and a lot of the time that doesn’t seem to help very much.
Before we discuss how a NUCCA doctor assesses and aligns the atlas bone, let’s discuss what is actually happening when the atlas bone is aligned and how this can help the strength and conditioning world. First we need to understand that we have six senses, not five:
1. Vision 2. Hearing 3. Smell 4. Taste 5. Touch
Our sixth sense is position sense or otherwise known as mechanoreception. There are two types of mechanoreception:
1. Conscious: This is when you know where parts of your body are, even if you can’t see them. For example, you always know where your feet are, even when you can’t see them during everyday activities.
2. Unconscious: This is when your mechanoreceptors are sending information to your brain that you are unaware of. For example, you don’t know that your L3 vertebra is out of alignment, or you don’t know that your right hip is tilted higher than your left hip.
Most of the brain is actually dedicated to responding to position sense. When the brain is responding to conscious and unconscious position sense, it is sending signals throughout the body that effect levels of mobility and stability at different joints. If the atlas bone is sending a message of asymmetry to the brain, then for example, the scapula might become misaligned which can then cause stiffness in the glenohumeral joint, a joint that needs to be mobile. This stiffness is a protective mechanism that can happen to any joint in the body when the brain is getting an asymmetrical signal from the atlas bone.
The upper cervical spine has by far the most position sense nerves compared to any other part of the body, because it is so close to the brain. Ironically, the part of the spine that has the greatest amount of mobility is the C1-C2 joint (atlas-axis). When we turn our head to the side, 55 percent of this movement happens at the atlas-axis joint.
Because this joint has so much mobility, it doesn’t have a lot of stability to protect it. This means our atlas-axis joint is very vulnerable to injury, stress and misalignment. We need to gain as much stability at the atlas joint as possible in order to protect the joint.
A way to help gain stability at the atlas-axis joint is to get the joint checked for misalignment and adjusted when needed on a regular basis. Over time, the body can learn and gain the necessary stability to keep the atlas-axis joint aligned and symmetrical during everyday movement and activity. Like anything else, the atlas bone needs to practice being in alignment.
Now, I am not saying that when the atlas bone is symmetrical, the whole body will suddenly operate with perfect symmetry. Past injury, motor control issues, strength imbalances and poor lifestyle choices will still challenge movement quality and increase the risk of injury. But, when the atlas bone is symmetrical, it will be easier for an athlete to deadlift with maximal strength production, sprint with maximum motor control, or be able to correct their left leg strength deficit compared to their right leg. Until the brain is getting a symmetrical signal from the atlas bone, these improvements will be more difficult to accomplish.
One of the more important understandings that we have come across in regards to injury prevention is asymmetry. Asymmetry anywhere in the body seems to give us the highest chance for non-contact injury. The number one reason to have atlas bone alignment is to give the brain a symmetrical signal that will be spread throughout the nervous system. When the brain receives an asymmetrical signal from the atlas bone, asymmetrical posture and or movement will take place, because the body has no other choice. The body will adapt and move around asymmetries in order to survive. This is very unhealthy for the human body and can affect, among other things, the immune system, hormonal function, blood flow control and cause pelvic and shoulder girdle alignment problems.
If an athlete’s atlas bone is misaligned and their brain is getting an asymmetrical signal, they may not be able to reach full athletic potential, because their nervous system will not be at its highest level of efficiency. This will not allow them to reach their highest level of mobility, motor control, strength and power. And most importantly, they will not be able to reach their highest level of potential injury reduction.
So how can a NUCCA doctor facilitate atlas bone alignment? First, the patient is put on a scale that shows how much weight is on each leg while standing (I had 16 more pounds on my right leg, a definite asymmetrical problem). This scale also has an apparatus that checks high, low or rotated hip and shoulder alignment.
This procedure gives the doctor the first bit of information about the level of asymmetry in the patient. The doctor will then perform a strength test of the hip flexors. This is done while the patient is lying on their back. With both legs fully extended, the patient holds one leg 45 degrees off the ground against manual resistance. This gives the doctor another look into spinal misalignment by checking the strength, or lack of strength in the hip flexors. It appears that because of the attachment of the psoas muscle to the lumbar spine, hip flexion strength is often directly affected by spinal misalignment.
The doctor then takes spinal x-rays of the patient. The x-rays give the doctor the last bit of information needed, which is the exact misalignment of the skull and spinal cord. The doctor then uses mathematical measurements from the x-rays to see the angle needed to approach the atlas bone during the adjustment.
This adjustment technique is done with gentle touches around the side of the skull. At first, I thought this was insane. I couldn’t believe it would work, but thankfully one thing that has helped me in my career is that I try to never dismiss an idea until I give it a shot.
The first time I got adjusted, I found that this technique works with amazing precision. I immediately felt a tingling sensation down my left arm and leg. When I stood up, for the first time since junior high school, I could fully bend backwards extending my lumbar spine pain free.
Also, I could stand, just in general, without any pain in my low back or neck. I went back on the doctor’s scale and I had a perfectly symmetrical amount of weight on each leg and was much stronger in the hip flexion test. I felt like a giant weight of locked up tension had been released from my body.
I was walking around the office without the normal feeling of stiffness and pain I’d had in my neck and back. These changes can happen because the body can experience proper nerve flow when the spine is in alignment. Proper nerve flow from the spine to the extremities is key for efficient movement.
Now, just like any new gain of symmetry, mobility or strength, atlas bone alignment needs continued maintenance and work. I played football for eight years in high school and college, and unfortunately during those years, did a lot of incorrect weightlifting that took an extreme toll on my spinal health.
It has taken me three years of getting my alignment checked and often adjusted weekly before I have gained enough stability and strength to hold my alignment consistently. Now, I almost always know when my alignment is out and when it is in.
I have learned what kind of pain or stiffness accompanies my misalignment and I am not as strong or mobile when under this kind of stress. When I am holding my alignment, though, I can feel an increase in my strength and mobility. Movement feels easier and more coordinated.
I would advise anyone to look up a NUCCA doctor near them. Even if you decide not to participate in treatment, you can still try and learn valuable information from them. The textbooks referenced for this article also give information on how the brain, spinal cord and nervous system work together to effect human movement.
Jeremy Lawson MS, CSCS, is Head Strength & Conditioning Coach at Marin Catholic High School in Kentfield, CA.
Cook, G., Burton, L., Kiesel, K., Rose, G., & Bryant, M.F. (2010). Movement, Functional Movement Systems: Screening, Assessment and Corrective Strategies. Santa Cruz, CA: On Target Publications.
Eriksen, K. (2004). Upper Cervical Subluxation Complex: A Review of the Chiropractic and Medical Literature. Lippincott Williams and Wilkins.
Thomas, M.D., ed. (2002). National Upper Cervical Chiropractic Association Protocols and Perspectives. Monroe, Michigan: National Upper Cervical Chiropractic Research Association.
It is quite unfortunate that your publication would publish information regarding the pseudo-science of chiropractic. The subluxation theory has never been proven but continues to persist due to excellent marketing and sales by chiropractors and those that “buy” their product such as the author of this article. The medical definition of a subluxation is a partial dislocation of a joint. If an individual had a subluxation in the upper cervical region that last thing an individual would want would be an “adjustment.” Truthfully I had a hard time reading this article as I was disgusted throughout its entire length. The fact that the author makes the statement “It has taken me three years of getting my alignment checked and often adjusted weekly before I have gained enough stability and strength to hold my alignment consistently. Now, I almost always know when my alignment is out and when it is in” proves that the author has been sold on the chiropractic theory which has never been proven in research. I think that your publication did a great disservice to its readers by publishing this article. Dan Curtis, PT, DPT, MTC Physical Therapist, Doctor of Physical Therapy
— There is not one shred of evidence to support this article. It is totally irresponsible to publish something like this as mainstream management of athletic performance when there are no RCTs to support this claim. There are many more legitimate and scientifically proven methods of improving sports performance that can and should be discussed here. I’m extremely disappointed in your choice to publish this here. Mark A. Anderson, PT, PhD, ATC Professor University of Oklahoma Health Sciences Center Department of Rehabilitation Sciences
— Editor’s note: Thank you, Mark and Dan, for your comments. Please note that the above text is a blog, not an article in our magazine. The articles in our magazine are carefully reviewed, while our blogs strive to provide new ideas, including those off the beaten path. This particular blog presents one strength coach’s anecdotal experience with a topic that we’re hoping is interesting to our audience. We leave it up to the reader whether to be curious and learn more about a topic or reject it for a lack of research.
— Thank you Dan and Mark for taking the time to read my article. Here is a research study on upper cervical adjustments.
Upper cervical adjustments are very new to the research world. There are currently other research projects being done on upper cervical adjustments that have not yet been completed. They will be completed in the future to give us more insight into the procedure. It’s important for all of us in the human performance world to remember that all aspects of science have to be studied for the “first time.” Many subjects take on scrutiny when they are first studied.